127 articles - From Friday Apr 21 2023 to Friday Apr 28 2023
Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…
| Clin Gastroenterol Hepatol |
Prevention of Hepatocellular Carcinoma (HCC). White Paper of the Texas Collaborative Center for Hepatocellular Cancer (TeCH) Multi-stakeholder Conference. We call for a statewide (1) viral hepatitis elimination program; (2) program to increase NASH and Obesity Awareness; (3) research program to develop health care models that integrate alcohol associated liver disease treatment and treatment for alcohol use disorder; and (4) demonstration projects to evaluate the effectiveness of identifying and linking patient with advanced fibrosis and cirrhosis to clinical care. |
| Endoscopy |
Gastrointestinal endoscopy devices and the European Union Medical Device Regulation: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Private European companies called "notified bodies" are entitled to conduct device approval for the EU. The ESGE will actively engage with these notified bodies for topics related to the new endoscopy device approval process to ensure continued access to high quality endoscopy devices for endoscopists in Europe. |
| Gastroenterology |
AGA Clinical Practice Update on Gastric Peroral Endoscopic Myotomy for Gastroparesis: Commentary. Methods This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. This expert commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of the authors who are advanced endoscopists with expertise in treating patients by performing third-space endoscopy and gastric peroral endoscopic myotomy. |
| J Hepatol |
EASL-ILCA Clinical Practice Guidelines on Intrahepatic Cholangiocarcinoma. Nonetheless, in the last few years, progress has been achieved in molecular characterization, surgical management and targeted therapies. The recent advance together with the awareness that iCCA represents a distinct entity amongst the CCA family, led the ILCA and EASL governing boards to commission and charge international experts to draft dedicated guidelines to aid physicians towards an evidence-based approach for the diagnostic, prognostic, and therapeutic management of iCCA. |
meta-analyses and systematic reviews
| Aliment Pharmacol Ther |
Meta-analysis: Prevalence of significant or advanced fibrosis in adults with alpha-1-antitrypsin deficiency. More than one in five adult individuals with AAT deficiency and Z homozygosity harbour significant fibrosis, and nearly 1 in 10 harbours advanced fibrosis. The risk of fibrosis increases incrementally with the frequency of Pi*Z mutations. |
| Clin Gastroenterol Hepatol |
Endoscopy unit level interventions to improve adenoma detection rate - a systematic review and meta-analysis. The provision of report cards and the presence of an additional observer to identify polyps are associated with improved ADR and should be considered for implementation in endoscopy facilities. |
| Endosc Int Open |
Topical hemostatic agents in the management of upper gastrointestinal bleeding: a meta-analysis. This is especially true in novel subgroup analyses that assessed immediate hemostasis and rebleeding among RCTs and in malignant bleeding. Due to methodological limitations of available data, additional studies are needed to ascertain their effectiveness more confidently in the management of patients with UGIB. |
| Gastroenterology |
| Gastrointest Endosc |
Diagnostic Accuracy of Convolutional Neural Network Based Machine Learning Algorithms in Endoscopic Severity Prediction of Ulcerative Colitis: A Systematic Review & Meta-Analysis. CNN-based machine learning algorithms demonstrated excellent pooled diagnostic accuracy parameters in the endoscopic severity assessment of UC. Utilizing UCEIS scores in CNN training might offer better results than MES. Further studies are warranted to establish these findings in real-life. |
RCT, clinical trials, retrospective studies, etc…
| Aliment Pharmacol Ther |
Altered serum bile acid composition is associated with cardiac dysfunction in cirrhosis. Increased serum concentrations of conjugated BA are associated with several cardiac parameters, indicating a potential role in the development of hyperdynamic circulation and cardiac dysfunction in cirrhosis. Moreover, taurine-conjugated BA are associated with portal hypertension. |
Physiologically based pharmacokinetic modelling to predict intragastric rifabutin concentrations in the treatment of Helicobacter pylori infection. PBPK modelling showed rifabutin 50 mg three times daily had higher intragastric exposure times than 150 mg once daily or twice daily, or 300 mg once daily. This low-dose rifabutin regimen provides the highest potential for H. pylori eradication while minimising systemic rifabutin exposure. |
| Am J Gastroenterol |
Characteristics of Facilities with Early and Rapid Ustekinumab Adoption for Patients with Inflammatory Bowel Disease. Facility variation in medication adoption provides an opportunity for improving IBD care through targeted dissemination strategies to improve medication uptake. |
Natural history of anal ulcerations in pediatric-onset Crohn's disease: long-term follow-up of a population-based study. Anal ulceration is frequent in pediatric-onset CD, with nearly half of patients presenting with at least one episode after 10 years of evolution. Fistulizing perianal CD is twice as frequent in patients with present or past anal ulceration. |
Prenatal, Intrapartum, and Neonatal Factors Increase Risk of Eosinophilic Esophagitis. Prenatal, intrapartum, and neonatal factors, particularly preterm birth and NICU admission, were associated with development of EoE. Further research is needed to elucidate the mechanisms underlying the observed associations. |
| Clin Gastroenterol Hepatol |
Pegbelfermin in patients with nonalcoholic steatohepatitis and compensated cirrhosis (FALCON 2): a randomized phase 2b study. FALCON 2 did not meet its primary endpoint, =1 stage improvement in NASH CRN fibrosis without NASH worsening assessed via biopsy. Pegbelfermin was generally well tolerated in this advanced NASH population. |
Pegbelfermin in patients with nonalcoholic steatohepatitis and stage 3 fibrosis (FALCON 1): a randomized phase 2b study. FALCON 1 did not meet its primary endpoint, =1 point decrease in fibrosis score without NASH worsening or NASH improvement without fibrosis worsening assessed via biopsy. Pegbelfermin was generally well tolerated during 48-weeks of treatment. |
| Endosc Int Open |
Benefits of precise endoscopic incision on post-dilation mucosal scars to treat refractory esophageal stricture after endoscopic submucosal dissection. No serious complications occurred in any patients who underwent ED + ERI. Therefore, ED + ERI is safe, feasible, and may serve as a useful therapeutic method for refractory esophageal stricture after ESD. |
Endoscopic entero-enteral bypass to treat postsurgical benign complications of hepatico-jejunostomy: Update of a 7-year single-center experience. The update of our experience with EEEB confirmed that in patients with BAEs after bilio-digestive anastomosis, EEEB allows successful long-term treatment of different BAEs in a tertiary referral center with an acceptable rate of related AEs. |
Personalized endoscopic surveillance and intervention protocols for patients with familial adenomatous polyposis: the European FAP Consortium strategy. We present a newly developed personalized endoscopic surveillance and endoscopic treatment strategy for patients with FAP aiming to prevent cancer, optimize endoscopic resources and limit the number of surgical interventions. Following this new strategy, prospectively collected data in a large cohort of patients will inform us on the efficacy and safety of the proposed approaches. |
| Endoscopy |
Artificial intelligence based polyp size measurement in gastrointestinal endoscopy using the auxiliary water jet as a reference. In this work, we present a novel AI-based method for measuring colorectal polyp size with significantly higher accuracy than other common sizing methods. |
| Gastrointest Endosc |
Comparing Per-pass Performance of Two Types of Needles for Endoscopic Ultrasound-Guided Fine Needle Biopsy of Pancreatobiliary Masses in a Randomized Trial. There was no significant difference in the diagnostic performance of the Franseen needle versus the 3-prong asymmetric tip needle in patients with suspected pancreatobiliary cancer. However, the Franseen needle yielded higher cellularity of the specimen. Two passes of FNB are required to detect malignancy with at least 90% sensitivity with either type of needle. number NCT04975620. |
EUS-guided GastroEnterostomy for management of malignant Gastric Outlet Obstruction: a prospective cohort study with matched comparison with Enteral Stenting. In this first, prospective, single-center comparison, EUS-GE showed excellent efficacy in relieving mGOO, with an acceptable safety profile and long-term patency, and several clinically significant advantages over ES. Whilst awaiting randomized trials, these results might endorse EUS-GE as first line strategy for mGOO, where adequate expertise is available. |
Factors Associated with Detection of Hereditary Diffuse Gastric Cancer on Endoscopy in Individuals with Germline CDH1 Mutations. Targeted biopsies of gastric pale mucosal areas and increasing number of biopsies taken on EGD were associated with detection of SRCC. SRCC foci were mostly detected in the proximal stomach, supporting updated endoscopic surveillance guidelines. Further studies are needed to refine endoscopic protocols to improve SRCC detection in this high-risk population. |
Impact of a scalable training program on the quality of colonoscopy performance and risk of post-colonoscopy colorectal cancer. A scalable online behavior-change training focused on modifiable factors was associated with significant and sustained improvements in ADR, particularly among endoscopists with lower ADRs. These ADR changes were associated with substantial reductions in their patients' risk of PCCRC. |
| Gut |
Genetic coding variant in complement factor B (CFB) is associated with increased risk for perianal Crohn's disease and leads to impaired CFB cleavage and phagocytosis. Objective Perianal Crohn's disease (pCD) occurs in up to 40% of patients with CD and is associated with poor quality of life, limited treatment responses and poorly understood aetiology. We performed a genetic association study comparing CD subjects with and without perianal disease and subsequently performed functional follow-up studies for a pCD associated SNP in is a loss-of-function mutation that impairs its cleavage, activation of alternative complement pathway, and pathogen phagocytosis thus implicating the alternative complement pathway and CFB in pCD aetiology. |
| Hepatology |
Class a capsid assembly modulator RG7907 clears HBV-infected hepatocytes through core-dependent hepatocyte death and proliferation. Our study unravels a previously unknown mechanism of action for CAM-As such as RG7907 in which HBc aggregation induces cell death, resulting in hepatocyte proliferation and loss of covalently closed circular DNA (cccDNA) or its equivalent, possibly assisted by an induced innate immune response. This represents a promising approach to attain a functional cure for CHB. |
| J Hepatol |
A randomized-controlled trial (TARGET-C) of high vs. low target mean arterial pressure in patients with cirrhosis and septic shock. A higher MAP strategy does not confer survival benefit in CIC patients, but helps with better tolerance of dialysis, lactate clearnce and renal recovery. Higher adverse events indicate need for better tools for evaluating target microcirculation pressures in CIC patients [NCT03145168] IMPACT AND IMPLICATIONS OF RESEARCH Maintaining an appropriate organ perfusion pressure during sepsis is the ultimate goal of hemodynamic management. A higher MAP improves renal outcomes in patients with hepatorenal syndrome. Cirrhosis patients with septic shock (CIC) have severe circulatory disturbances, low mean arterial pressure (MAP), and poor tissue perfusion. In these patients, targeting higher mean arterial pressure (MAP) versus lower MAP does not confer any survival benefit but is associated with more adverse events. A higher strategy was associated with better tolerance and lesser episodes of hypotension on dialysis. Patients who could achieve the higher target MAP, without the development of adverse events, had improved renal outcomes and better lactate clearance. Higher MAP was also associated with improvement in markers of endothelial function. A higher strategy of MAP, with a close monitoring of adverse events, may be recommended for patients with cirrhosis and septic shock. Clinical trial number NCT03145168. |
A randomized-controlled trial of ischemia-free liver transplantation for end-stage liver disease. Among patients with end-stage liver disease, IFLT, compared with conventional approach, significantly reduced complications related to ischemia reperfusion injury. Clinical trial registration |
A randomized controlled trial of SOF/VEL/VOX with or without ribavirin for retreatment of chronic hepatitis C. This randomized controlled trial showed equal, high efficacy of both regiments in retreating previous DAA failures, although ribavirin was associated with more adverse events. Therefore SOF/VEL/VOX monotherapy should be the preferred retreatment strategy. Impact and implications HCV treatment guidelines recommend retreating DAA treatment failures with the combination of sofosbuvir, velpatasvir and voxilaprevir (SOF/VEL/VOX) for 12 weeks. However, whether ribavirin exerts an additional/synergistic effect remains unclear. The present study confirmed that SOF/VEL/VOX without ribavirin is the best regimen for retreating DAA treatment failures, and thus will help clinicians caring for patients who are not cured with a first course of DAA therapy. CLINCIALTRIALS. Gov number NCT04695769. |
Hepatocyte dedifferentiation profiling in alcohol-related liver disease identifies CXCR4 as a driver of cell reprogramming. This study shows the association of hepatocyte dedifferentiation with disease progression and poor outcome in AH. Moreover, the transcriptomic profiling of HB cells revealed CXCR4 as a new driver of hepatocyte-to-biliary reprogramming and as a potential therapeutic target to halt hepatocyte dedifferentiation in AH. |
Hepatocytes undergo punctuated expansion dynamics from a periportal stem cell niche in normal human liver. These datasets support the existence of a periportal progenitor niche and indicate that clonal patches exhibit punctuated but slow growth, then quiesce, likely due to acute environmental stimuli. These findings crucially contribute to our understanding of hepatocyte dynamics in normal human liver. |
Using the ELF test, FIB-4 and NAFLD fibrosis score to screen the population for liver disease. The ELF test alone or combined with FIB-4 for liver fibrosis screening in the general population and at-risk groups reduces the number of futile referrals compared to FIB-4 and NFS, without overlooking true cases. Impact and implementations We need referral pathways that are efficient at detecting advanced fibrosis from alcohol-related and non-alcoholic fatty liver disease in the population, but without causing futile referrals or excessive use of resources. This study indicates that a sequential test strategy of FIB-4, followed by the ELF test in indeterminate cases leads to few patients referred for confirmatory liver stiffness measurement, while retaining a high rate of detected cases, and at low direct costs. This two-step referral pathway could be used by primary care for mass, targeted, or opportunistic screening for liver fibrosis in the population. Clinical trial number number NCT03308916. |
| Neurogastroenterol Motil |
Characteristics of disorders of gut-brain interaction in the Japanese population in the Rome Foundation Global Epidemiological Study. These findings support the study hypotheses. Data from Japan as a culturally homogenous country suggest Rome IV IBS is more severe and hence has more gut-brain psychobehavioral involvement than Rome III IBS. |
Clinical outcome of disorders of gut-brain interaction in secondary care: A longitudinal study. Two-thirds of DGBI patients in secondary care showed symptom improvement. Patients who were reassured had better symptom improvement, while those with an overlap syndrome were associated with a poorer outcome, resulting in greater healthcare consultation and work absenteeism. |
Clinical utility of colonic low-amplitude propagating contractions in children with functional constipation. s/inferences LAPCs do not seem to have added clinical significance in pediatric functional constipation; CM interpretation could rely primarily on the presence of HAPCs. LAPCs may represent failed HAPCs. Larger studies are needed to further validate these findings. |
Esophagogastric junction contractile integral (EGJ-CI) complements reflux disease severity and provides insight into the pathophysiology of reflux disease. This study re-affirms EGJ-CI as a reliable discriminator between reflux disease (Barrett's esophagus/ENRD) and FH. In borderline reflux patients, patients with a lower EGJ-CI score (<21.2 mmHg) appear to respond better to anti-reflux therapies compared to those with a higher value. |
High amplitude propagated contractions with Glycerin versus Bisacodyl: A within-subject comparison in children undergoing colonic manometry. HAPCs post Bisacodyl had a longer duration of action (median of 40 vs 21.5 min, p < 0.0001), longer propagation (median of 70 vs 60 cm, p = 0.02), and more HAPCs (median of 10 vs 5, p < 0.0001) compared Glycerin. No differences were found in the HAPC amplitude and onset of action between both medications. |
The microbiome in adolescents with irritable bowel syndrome and changes with percutaneous electrical nerve field stimulation. Firmicutes, including Clostridiaceae spp., and LCFA synthesis pathways were increased in IBS patients suggesting pain-potentiating effects. PENFS led to marked improvements in abdominal pain, functioning, and catastrophizing, while Clostridial species and LCFA microbial pathways decreased with treatment, suggesting these as potential targets for IBS centrally mediated treatments. |
Plenty of the editorials are available as full text through the publisher website using the provided link
| Aliment Pharmacol Ther |
| Clin Gastroenterol Hepatol |
Artificial Intelligence Applications in Hepatology. We would like to emphasize to the readers that most AI-based algorithms that will be discussed in this review are still considered in early development and their utility and impact on patient outcomes still need to be assessed in future large-scale and inclusive studies. Our vision is that the use of AI in hepatology will enhance physician performance, decrease the burden and time spent on documentation, and re-establish the personalized patient-physician relationship that is of utmost importance for obtaining good outcomes. |
Liver Transplantation 2023: Status Report, Current and Future Challenges. The rise in transplantation for ALD and NAFLD has brought attention to how patients are selected for transplantation and the strategies needed to prevent recurrent disease. In this review, we present a status report on the most pressing topics in liver transplantation and future challenges. |
New perspectives on development of curative strategies for chronic hepatitis B. Nucleos(t)ide analogues will likely remain an essential backbone of future combinations to control viral replication and prevent resistance to antiviral drugs. In this review, we discuss perspectives on approaches to achieving functional cure, with a review of virological and immunological strategies, highlighting challenges and unresolved questions with the various attempts to achieve cure, as well as exploring alternative endpoints such as partial cure and new non-invasive viral and immunological biomarkers to stratify patients and predict/monitor antiviral response. |
Recent Advances in the Management of Primary Sclerosing Cholangitis. However, recent innovations in the characterization, and prognostication, of patients with PSC, in addition to new tools for medical management and emerging pharmacologic agents, give rise to the potential for meaningful progress in the next several years. This review summarizes current concepts in PSC and highlights areas of particular areas in need of further study. |
| J Hepatol |
The role of ETV4 in HCC: How transcription factors can inform immunotherapy combination treatments. In conclusion, Xie et al 11 provides a framework for comprehensive profiling of TF dependencies in HCC by studying the role of ETV4 in promoting metastasis. By focusing on new combination therapy strategies targeting both upstream and downstream signaling pathways of aberrant TFs, especially pathways that create an immunosuppressive TME, they demonstrate an avenue for future studies in our tireless attempt to inhibit HCC progression and metastasis. |
| Neurogastroenterol Motil |
How to effectively use and interpret the barium swallow: Current role in esophageal dysphagia. Barium swallow remains a useful investigation in esophageal dysphagia, though its role has evolved due to advancements in other diagnostics. Current evidence-based guidance regarding its strengths, weaknesses, and current role are described in this review. |
Role of stimulator of interferon genes (STING) in the enteric nervous system in health and disease. STING can influence gastrointestinal motility and barrier function and therefore be involved in the pathophysiology of IBS and IBD. This mini review highlights the current knowledge of STING in the pathophysiology of CNS and gastrointestinal diseases as well as these newly uncovered roles STING in enteric neurons and glia. |
misc publications eg case reports, tools of the trade, images of the month, etc…
| Am J Gastroenterol |
| Clin Gastroenterol Hepatol |
| Endoscopy |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |
| Hepatology |
Letters to the editors and authors’ replies
| Aliment Pharmacol Ther |
| Gastroenterology |
| J Hepatol |